Intended for healthcare professionals

Education And Debate

Deliberate self harm in Sri Lanka: an overlooked tragedy in the developing world

BMJ 1998; 317 doi: (Published 11 July 1998) Cite this as: BMJ 1998;317:133
  1. Michael Eddleston (, research fellowa,
  2. M H Rezvi Sheriff, professorb,
  3. Keith Hawton, professorc
  1. a Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford OX3 9DU
  2. b Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
  3. c University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX
  1. Correspondence to: Dr Eddleston
  • Accepted 20 March 1998

The World Health Organisation's definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” clearly relates social and mental wellbeing to physical health.1 For many years, however, attempts to improve health in the developing world concentrated on physical illness—mental health was relegated to the bottom of the list of priorities.2 Only recently has it begun to appear at the forefront of international public health.3

Summary points

  • Deliberate self harm is common in the developing world

  • Self poisoning with agricultural pesticides or natural poisons such as oleander seeds is an important cause of mortality in many rural areas

  • Case fatality rates of pesticides such as paraquat and organophosphates may exceed 60%

  • Medical management of acute self poisoning is currently poor—better management protocols would reduce mortality

  • Research to improve management and find ways of reducing deliberate self harm is urgently required

Fig 1

Bed occupancy in relation to diagnosis in the medical intensive care unit of Anuradhapura General Hospital, Sri Lanka, 1995-6

Self poisoning in Sri Lanka

Sri Lanka has a high incidence of suicide—at least 40 suicides per 100 000 population each year compared with 8 per 100 000 in the United Kingdom. 4 5 As part of a collaboration between the universities of Colombo and Oxford, we have been studying new treatments for self poisoning in Anuradhapura General Hospital, a secondary referral centre for 900 000 people living in the North Central Province of Sri Lanka. Our work there has allowed us to observe at first hand the tragic consequences of these deaths for the families and the community.

During 1995 and 1996, 2559 adults (age range 12-73 years; 1443 men and 1116 women) were admitted to the …

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